Paul Fleming

The experience of the family caregivers' role: a qualitative study.

In Ireland, there is a dearth of research exploring the perceived health and social care needs and experiences of family caregivers of older people. In response, this research study was conducted to explore the profile, role and needs of family caregivers as a means of understanding their experience of caring. The study also set out to identify coping strategies employed by caregivers and explore positive aspects of the caring relationship in relation to quality of life, information needs, day care and respite care, transport and emotional support. A multimethod approach used interviews, focus groups and postal questionnaires. In the main study a pretested questionnaire, comprising closed and open questions was used with a stratified, systematically randomized sample of caregivers in urban and rural home care settings, of which 52% of respondents to the questionnaire volunteered to partake in in-depth interviews. This article per deals predominantly with the findings arising from 10 in-depth qualitative interviews. The data yielded a rich and meaningful picture of the caregiving experience, profiling the complex nature of this diverse and multifaceted role. Findings showed that three main categories emanated from the data: the caring role-context and attitudes, the impact of caring and the need to support the carers’ role. The need to develop continually an understanding of the effectiveness of specific health and social care interventions was also of paramount importance. The anticipated continuing demand for family care means that caregivers’ needs and perspectives need to be integrated into future service planning and decision-making processes, in partnership with statutory and voluntary bodies. While this was the first study of its type in Ireland, the issues raised reflect the findings of other published studies and have important lessons for family carers and health care practitioners generally.

Attitudes, knowledge and behaviours with regard to skin cancer: A literature review

In recent years there has been a dramatic increase in the prevalence of skin cancer worldwide. There has been a huge amount of research literature on skin cancer especially in the last 10-15 years. There is no doubt that this is in direct relation to the increases in prevalence of the disease on a worldwide basis. Australian and American research has led in the field and again it is probable that this has been due to the increase in rates of skin cancer in those countries. This paper provides a comprehensive review of the existing international literature in the area.

General Practitioners involvement in enteral tube feeding at home: a qualitative study

BackgroundComplex medical treatment is moving from hospital to primary care and General Practitioners (GPs) are increasingly asked to undertake new roles. There are now an estimated 19,500 patients being fed in the UK in the community on enteral tube feeding using a variety of different feeding tubes (Percutaneous endoscopic gastrostomy (PEG), Jejunostomy, or nasogastric (NG). The majority of patients are over the age of 65 years when they had artificial feeding initiated and mainly because of dysphagia. The aim of this study was to explore GPs knowledge, attitudes and skills relating to enteral feeding in the community.MethodsSemi-structured one-to-one interviews with a convenience sample of GPs in Northern Ireland.ResultsTwenty-three GPs in three health boards in Northern Ireland participated in the study. Most found dealing with enteral feeding to be a predominantly negative experience. They had little involvement in patient selection for the procedure and poor or no discharge information. GPs felt inadequately trained, there was poor communication between primary and secondary care and little support. There was anger and frustration among GPs about lack of resources (funding and training), and the perception that primary care was used as a dumping ground.ConclusionMoving complex medical treatment from secondary to primary care has major implications for GPs who should be included in the patient selection process, have adequate discharge information about their patients, be adequately resourced and have appropriate support and training.

Sexual health promotion in primary care – activities and views of general practitioners and practice nurses

Background Sexual health in Northern Ireland (NI) is poor compared with the rest of Europe with increasing incidences of sexually transmitted infections and one of the highest rates of teenage pregnancy. Traditionally, sexual health services have been provided in a fragmented way by a wide range of different providers but recent sexual health strategies have flagged sexual health as a key activity within the primary care setting.Aim The main aim of the study was to assess the sexual health promotion activities within the primary care setting across one Health and Social Services Board in NI.Methods A series of semi-structured interviews with both general practitioners (GPs) and practice nurses (PNs) was conducted to assess their views on the key issues in relation to sexual health in primary care. A questionnaire survey was also conducted with these health professionals to elicit information about sexual health promotion activities within the primary care setting.Findings The results have shown that promoting sexual health within the primary care setting is often ad hoc and often does not target the ‘at-risk’ population. As such, GPs and PNs tend not to discuss sexual health with non-heterosexual clients or those with learning disabilities due to lack of awareness and training. Health professionals feel inadequately trained to engage in effective sexual health promotion and to provide enhanced sexual health services. Personal embarrassment and lack of time were also identified as barriers for providing effective sexual health care.Conclusion Health professionals within the primary care setting require additional training to deal with the sensitive and complex issues inherent in the area of sexual health.

An exploration of the health and social wellbeing needs of looked after young people--a multi-method approach

This study, which was undertaken in Northern Ireland, aimed to identify how the promotion of the health and social wellbeing of looked after young people could be enhanced using a four-stage triangulated research design employing qualitative and quantitative elements. Stage 1 sought to identify relevant health issues from a representative sample of case files and found low uptake of statutory medical assessments, relatively few physical health problems and higher levels of mental health and behavioural problems including self-esteem and self-image issues. Stage 2 sought to ascertain, through two focus groups, the views of those caring for looked after young people - foster carers and residential social workers. Findings showed that both groups perceive themselves in a health promoting role with the main issues encountered being the need for support in issues such as sex education and access to sources of help and aids to health promotion. Stage 3 sought to listen to the needs and concerns of the young people and their parents through a series of semi-structured interviews. These revealed the need of parents for involvement with their childs care and identification of the social worker as holding primary responsibility for health. Young people had positive views of health, identified stressors and perceived that too much help was given in relation to health issues; social workers were preferred for discussion of sensitive subjects. It was concluded that the multiple needs of young people give excellent opportunities for the development of interdisciplinary working in the context of multi-sectoral involvement to support effective health promotion interventions.

An exploration of public knowledge of warning signs for cancer

BACKGROUND Warning signs of cancer have long been used as an effective way to summarise and communicate early indications of cancer to the public. Given the increasing global burden of cancer, the communication of these warning signs to the public is more important than ever before. AIM This paper presents part of a larger study which explored the attitudes, knowledge and behaviours of people in mid-life towards cancer prevention. The focus of this paper is on the assessment of the knowledge of members of the public aged between 35 and 54 years of age. METHOD A questionnaire was administered to a representative sample of the population listing 17 warning signs of cancer. These included the correct warning signs and distracter signs. Respondents were asked to correctly identify the seven warning signs. RESULTS Findings show that respondents could identify 4.8 cancer warning signs correctly. Analysis by demographics shows that being female, being older, having a higher level of educational attainment and being in a higher socio-economic group are predictors of better level of knowledge of cancer warning signs. RECOMMENDATIONS Recommendations are proffered with regard to better targeting, clarification and communication of cancer warning signs.

Ethical dilemmas and human rights considerations arising from the evaluation of a smoking policy in a health promoting setting.

One of the key challenges in managing the Health Promoting Workplace is the development of an effective policy for the control of environmental tobacco smoke (ETS). This paper explores the ethical consequences raised when the implementation of such a policy was evaluated in a large multi-campus university. In a three-stage evaluation, the first stage involved a qualitative enquiry with the Health and Safety Committee to obtain the management perspective on the working of the policy. A survey of the perception of the ETS policy and smoking behaviours with a representative sample of staff and students constituted the second stage. In the final stage the Health and Safety Committee was engaged with the findings of stages 1 and 2 to develop a response to the evaluation. The ethical implications which arise from this evaluation centre, firstly, on the underlying reasons for undertaking an evaluation. Secondly, consideration is given to the consequences of applying utilitarian principles to smoking policy for the minority who smoke and thus find their work or study patterns affected by a smoking ban. Such a ban limits their autonomy and while it may be helpful (beneficent) in terms of their longer-term physical health, it may have harmful (maleficent) effects on their psychological wellbeing and the potential for negative consequences if they choose to contravene the ban on smoking. The implications of addressing this situation are explored.

Enhancing the empowerment agenda in health promotion through reflective practice

The formal practice of reflection is a relatively unknown concept in health promotion. A reflexive approach to health promotion practice normally resides in debates regarding the theory and practice of health promotion; there have been few formal attempts to develop reflective practice. This paper describes a conceptual typology for reflective practice which focuses on three domains relating to the role of self, the context of practice and the process of programme planning and delivery. These domains are interrogated by a taxonomy of reflective questions tailored to the requirements and timing of the reflection. An exemplar reflective application of the typology in this paper focused on the evaluation of the smoking policy in a large university. Reflection centred on how the empowerment of those working and studying in the institution was affected by the evaluation process.

A rapid appraisal method for reviewing the effectiveness of workplace smoking policies in large and medium sized organisations.

Workplace smoking policies have been developed in response to growing scientific evidence about the harmful effects of environmental tobacco smoke (ETS), increasing opposition from non-smokers, con cern over escalating costs of health damage and pro ductivity losses, and the emergence of relevant laws and codes of good practice. Much has been written on the development and implementation of workplace smok ing policies, but little about their evaluation. This paper describes a rapid appraisal method for the evaluation of workplace smoking policies. The four-stage process involves rapid, focused consultation with policy makers in the workplace, appropriate risk assessment, rapid consultation with those affected by the policy and focused feedback of results for planning and ongoing monitoring. In the pilot site the existing health and safe ty committee members were effective informants for the identification of key issues in smoking policy The risk assessment phase was incorporated into the main appraisal which involved a canvass of staff and others on ETS issues identified by the informants. In the final stage of the process the health and safety committee proved to be both responsive to identified need, and proactive in facilitating ongoing review of the smoking policy. It therefore proved possible to develop the rapid appraisal process for administration in a limited time frame, three months for the whole process, with the rapid canvass element being achieved within one week.

Managers’ understanding of workplace health promotion within small and medium-sized enterprises A phenomenological study

Objective: This study aimed at exploring managers’ understanding of workplace health promotion and experiences of workplace health promotion activity within small and medium-sized enterprises. Design: A Heideggerian interpretive phenomenological methodology was adopted. Setting: This study was undertaken with small and medium-sized enterprise managers from a Health and Social Care Trust area of Northern Ireland. Method: In-depth telephone interviews were carried out with a purposive sample of 18 small and medium-sized enterprise managers. Data was analysed using Benner’s strategy for data analysis. Results: ‘Workplace health promotion as a symbiosis of health and business’ emerged as a main theme from the data. Participants considered workplace health promotion as a key means of harnessing the potential of both their business and their employees: providing protection from harm and opportunities for health improvement for employees and affording protection for the viability and reputation of the business. Participants also viewed themselves as holding a pivotal role in the development and implementation of workplace health promotion activities. Conclusion: Strategies focussing on employee health alone as a separate entity to the business agenda are likely to be ineffective for raising awareness of workplace health promotion activity within small and medium-sized enterprises. Findings suggest an integrated ecological approach needs to be reflected within policy and practice that extends beyond the individual employee. A revised programme planning framework, based upon the work of Green and Kreuter, identifies areas that health promotion practitioners need to consider for more meaningful engagement with workplace health promotion activity by managers to take place within the small and medium-sized enterprise setting.